For more than 33 years, the Magaziner Center has been leading the way in cutting-edge, non-surgical, regenerative medicine. Our Center has successfully performed regenerative procedures on people of all ages and activity levels. Our treatments have enabled professional athletes to play again, weekend warriors to avoid joint-replacement surgery and patients regain lost mobility after a failed operation, accident or injury.
Rather than covering up the symptoms with risky painkillers or anti-inflammatory drugs, we heal the source of the injury by regenerating the tissue of the joint. By treating in this way, rather than just addressing the symptoms, our patients generally experience excellent clinical outcomes without harmful and debilitating side effects. This brings us to our discussion about cortisone and shoulder pain.
Why do people get cortisone injections for shoulder pain?
A tear in the rotator cuff produces pain and also contributes to instability in the shoulder joint. If severe, there may be weakness or an inability to lift the arm, there will certainly be pain. An examination of the shoulder may reveal inflammation that is causing limited range of motion in the arm and the subsequent pain. Pain at rest and at night, particularly if lying on the affected shoulder, and the subsequent lack of sleep often make patients eager to try anything that will help them. This search for relief may include over-the-counter medications, prescription Non-Steroidal Anti-Inflammatory medications (NSAIDs), and eventually steroid injections. All these treatments are designed to pain manage the patient for as long as possible or until they are no longer effective and a surgical recommendation is given.
There has been concern in the medical community as to what these cortisone injections are doing to the shoulder. Numerous studies have suggested the cortisone injections breaks down healthy tissue and will weaken the connective tissue and destroy the bones of the joints they are injected into.
An October 2019 (1) study questioned the safety of corticosteroid injections by describing four main adverse findings that have been structurally observed in patients after cortisone injections.
1. Cortisone injections cause accelerated osteoarthritis progression.
2. Cortisone injections weakens bone and causes subchondral (the bone beneath the joint cartilage) insufficiency fracture.
3. Cortisone injections not only weakens bone, but causes bone death and complications of osteonecrosis.
4. Cortisone injections cause rapid joint destruction.
Repeated corticosteroid injection in the shoulder puts you at greater risk for needing, not one shoulder surgery, BUT TWO.
A recent 2017 study (2) suggested that despite advances in surgical reconstruction of chronic rotator cuff tears leading to improved clinical outcomes, failure rates of 13-94% have been reported. There can be many factors for why a surgical repaired rotator cuff can re-tear. Two 2019 studies suggest the cortisone may be a culprit.
A December 2019 study (3) led by Tufts Medical Center suggests that a steroid injection in the shoulder before surgery, puts you at greater risk for post-surgical complications and worse, the need for a secondary or revision shoulder surgery. Here is what the study says: “Several recent clinical trials have demonstrated that corticosteroid injections are correlated with increased risk of revision surgery after arthroscopic rotator cuff repair. . . Caution should be taken when deciding to inject a patient (with corticosteroid), and this treatment should be withheld if an arthroscopic rotator cuff repair is to be performed within the following six months.”
A January 2019 study (4) lead by the Mayo Clinic examined the impact of one or more shoulder corticosteroid injections a patient may have received for shoulder pain up to a year prior to having rotator cuff repair. The question they asked, does this injection or injections cause the need for revision rotator cuff surgery?
Here are the findings:
“A single shoulder injection within a year prior to arthroscopic rotator cuff repair was not associated with any increased risk of revision surgery; however, the administration of 2 or more injections was associated with a substantially increased risk of subsequent revision rotator cuff surgery. . . caution is recommended when considering more than 1 shoulder corticosteroid injection in patients with potentially repairable rotator cuff tears.”
Options to cortisone and surgery
If you had cortisone injections and want to explore non-surgical options for your rotator cuff problems. Please consider a consultation with us.
At the Magaziner Center, we have great success helping to relieve chronic shoulder pain. Our patients are as diverse as professional athletes, weekend warriors and seniors suffering from arthritis. The treatments we use include prolotherapy, platelet-rich plasma, cellular regenerative therapies, and osteopathic manipulative therapy with the goal of accelerating and enhancing the body’s natural healing process. Many patients have come to us after having been through years of unsuccessful, mainstream medical treatments, and have finally found the lasting relief they’re seeking at the Magaziner Center, with none of the side effects that prescription-based medicine often produces.
If you would like to explore more information about patient care, please contact our office so we can start a conversation with you.
1 Andrew J. Kompel, Frank W. Roemer, Akira M. Murakami, Luis E. Diaz, Michel D. Crema, Ali Guermazi Intra-articular Corticosteroid Injections in the Hip and Knee: Perhaps Not as Safe as We Thought? Published Online:Oct 15 2019 https://doi.org/10.1148/radiol.2019190341
2 Zumstein MA, Lädermann A, Raniga S, Schär MO. The biology of rotator cuff healing. Orthop Traumatol Surg Res. 2016 Dec 30. pii: S1877-0568(16)30191-8. doi: 10.1016/j.otsr.2016.11.003.
3 Puzzitiello RN, Patel BH, Nwachukwu BU, Allen AA, Forsythe B, Salzler MJ. Adverse impact of corticosteroid injection on rotator cuff tendon health and repair: A systematic review. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2019 Dec 17.
4 Desai VS, Camp CL, Boddapati V, Dines JS, Brockmeier SF, Werner BC. Increasing numbers of shoulder corticosteroid injections within a year preoperatively may be associated with a higher rate of subsequent revision rotator cuff surgery. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2019 Jan 1;35(1):45-50.